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Which performance improvement model should the infection preventionist use to aid in the evaluation of the infection control plan?
A. Failure mode and effects analysis
B. Six Sigma
C. Plan, Do, Study, Act
D. Root Cause Analysis
Answer: C
Explanation:
The Plan, Do, Study, Act (PDSA) model is a widely used performance improvement tool in infection prevention. It focuses on continuous quality improvement through planning, implementing, analyzing data, and making adjustments. This model aligns with infection control program evaluations and The Joint Commission's infection prevention and control standards.
Why the Other Options Are Incorrect?
* A. Six Sigma - A data-driven process improvement method but not as commonly used in infection control as PDSA.
* B. Failure Mode and Effects Analysis (FMEA) - Used to identify risks before implementation, rather than ongoing evaluation.
* D. Root Cause Analysis (RCA) - Used to analyze failures after they occur, rather than guiding continuous improvement.
CBIC Infection Control Reference
The PDSA cycle is a recognized model for evaluating and improving infection control plans.
NEW QUESTION # 155
Which of the following BEST demonstrates the effectiveness of a program targeted at reducing central-line associated bloodstream infections (CLABSIs) in an intensive care unit (ICU)?
A. A 30% reduction in the use of antibiotic-impregnated central catheters over 6 months
B. A 30% decrease in total costs related to treatment of CLABSIs over 12 months
C. A 25% decrease in the length of stay in the ICU related to CLABSIs
D. A 25% reduction in the incidence of CLABSIs over 6 months
Answer: D
Explanation:
Evaluating the effectiveness of a program to reduce central-line associated bloodstream infections (CLABSIs) in an intensive care unit (ICU) requires identifying the most direct and relevant measure of success. The Certification Board of Infection Control and Epidemiology (CBIC) emphasizes outcome-based assessment in the "Performance Improvement" and "Surveillance and Epidemiologic Investigation" domains, aligning with the Centers for Disease Control and Prevention (CDC) guidelines for infection prevention. The primary goal of a CLABSI reduction program is to decrease the occurrence of these infections, with secondary benefits including reduced length of stay, costs, and resource use.
Option B, "A 25% reduction in the incidence of CLABSIs over 6 months," is the best demonstration of effectiveness. The incidence of CLABSIs-defined by the CDC as the number of infections per 1,000 central line days-directly measures the program's impact on the targeted outcome: preventing bloodstream infections associated with central lines. A 25% reduction over 6 months indicates a sustained decrease in infection rates, providing clear evidence that the intervention (e.g., improved insertion techniques, maintenance bundles, or staff education) is working. The CDC's "Guidelines for the Prevention of Intravascular Catheter-Related Infections" (2017) and the National Healthcare Safety Network (NHSN) protocols prioritize infection rate reduction as the primary metric for assessing CLABSI prevention programs.
Option A, "A 25% decrease in the length of stay in the ICU related to CLABSIs," is a secondary benefit.
Reducing CLABSI-related length of stay can improve patient outcomes and bed availability, but it is an indirect measure dependent on infection incidence. A decrease in length of stay could also reflect other factors (e.g., improved discharge planning), making it less specific to program effectiveness. Option C, "A 30% decrease in total costs related to treatment of CLABSIs over 12 months," reflects a financial outcome, which is valuable for justifying resource allocation. However, cost reduction is a downstream effect of decreased infections and may be influenced by variables like hospital pricing or treatment protocols, diluting its direct link to program success. Option D, "A 30% reduction in the use of antibiotic-impregnated central catheters over 6 months," indicates a change in practice but not necessarily effectiveness. Antibiotic-impregnated catheters are one prevention strategy, and reducing their use could suggest improved standard practices (e.g., chlorhexidine bathing), but it could also increase infection rates if not offset by other measures, making it an ambiguous indicator.
The CBIC Practice Analysis (2022) and CDC guidelines emphasize that the primary measure of a CLABSI prevention program's success is a reduction in infection incidence, as it directly addresses patient safety and the program's core objective. Option B provides the most robust and specific evidence of effectiveness over a defined timeframe.
References:
* CBIC Practice Analysis, 2022.
* CDC Guidelines for the Prevention of Intravascular Catheter-Related Infections, 2017.
* NHSN CLABSI Surveillance Protocol, 2021.
NEW QUESTION # 156
What question would be appropriate for an infection preventionist to ask when reviewing the discussion section of an original article?
A. Is the study question important, appropriate, and stated clearly?
B. Are criteria used to measure the exposure and the outcome explicit?
C. Could alternative explanations account for the observed results?
D. Was the correct sample size and analysis method chosen?
Answer: C
Explanation:
When reviewing the discussion section of an original article, an infection preventionist must focus on critically evaluating the interpretation of the study findings, their relevance to infection control, and their implications for practice. The discussion section typically addresses the meaning of the results, compares them to existing literature, and considers limitations or alternative interpretations. The appropriate question should align with the purpose of this section and reflect the infection preventionist's need to assess the validity and applicability of the research. Let's analyze each option:
* A. Was the correct sample size and analysis method chosen?: This question pertains to the methodology section of a research article, where the study design, sample size, and statistical methods are detailed.
While these elements are critical for assessing the study's rigor, they are not the primary focus of the discussion section, which interprets results rather than re-evaluating the study design. An infection preventionist might ask this during a review of the methods section, but it is less relevant here.
* B. Could alternative explanations account for the observed results?: The discussion section often explores whether the findings can be explained by factors other than the hypothesized cause, such as confounding variables, bias, or chance. This question is highly appropriate foran infection preventionist, as it encourages a critical assessment of whether the results truly support infection control interventions or if other factors (e.g., environmental conditions, patient factors) might be responsible. This aligns with CBIC's emphasis on evidence-based practice, where understanding the robustness of conclusions is key to applying research to infection prevention strategies.
* C. Is the study question important, appropriate, and stated clearly?: This question relates to the introduction or background section of an article, where the research question and its significance are established. While important for overall study evaluation, it is not specific to the discussion section, which focuses on interpreting results rather than revisiting the initial question. An infection preventionist might consider this earlier in the review process, but it does not fit the context of the discussion section.
* D. Are criteria used to measure the exposure and the outcome explicit?: This question is relevant to the methods section, where the definitions and measurement tools for exposures (e.g., a specific intervention) and outcomes (e.g., infection rates) are described. The discussion section may reference these criteria but focuses more on their implications rather than their clarity. This makes it less appropriate for the discussion section specifically.
The discussion section is where authors synthesize their findings, address limitations, and consider alternative explanations, making option B the most fitting. For an infection preventionist, evaluating alternative explanations is crucial to ensure that recommended practices (e.g., hand hygiene protocols or sterilization techniques) are based on solid evidence and not confounded by unaddressed variables. This critical thinking is consistent with CBIC's focus on applying research to improve infection control outcomes.
:
CBIC Infection Prevention and Control (IPC) Core Competency Model (updated 2023), Domain I:
Identification of Infectious Disease Processes, which emphasizes critical evaluation of research evidence.
CBIC Examination Content Outline, Domain V: Management and Communication, which includes assessing the validity of research findings for infection control decision-making.
NEW QUESTION # 157
Occupational Health contacts the Infection Preventionist (IP) regarding exposure of a patient to an employee's blood during surgery. The employee is negative for bloodborne pathogens. What is theNEXT step regarding informing the patient of the exposure?
A. Disclose the exposure to the patient with the information that the staff member is negative for all bloodborne pathogens
B. The patient does not need to be informed since the employee is negative for all bloodborne pathogens
C. Since this was a solid needle and not a hollow bore needed, follow up is not required or need to be disclosed
D. Disclose the exposure to the patient's surgeon and allow surgeon to determine if patient should be informed
Answer: A
Explanation:
Even if the healthcare worker is negative for bloodborne pathogens, the patienthas the right to be informed of a potential exposure. Transparency builds trust and aligns with ethical obligations in patient care.
* TheAPIC Textstates:
"Providers should inform patients when an HAI or other exposure event occurs, regardless of whether the exposure results in harm or is caused by negligence." Courts and professional guidelines support disclosure.
* CBIC and OSHA guidelinesemphasize prompt and transparent reporting of exposures.
* OptionsC and Dare incorrect because the lack of infection does not negate the ethical duty to inform the patient.
References:
APIC Text, 4th Edition, Chapter 8 - Legal Issues and Patient Rights
NEW QUESTION # 158
Which of the following procedures has NOT been documented to contribute to the development of postoperative infections in clean surgical operations?
A. Shaving the site on the day prior to surgery
B. Prolonged preoperative hospital stay
C. Prolonged length of the operations
D. The use of iodophors for preoperative scrubs
Answer: D
Explanation:
Postoperative infections in clean surgical operations, defined by the Centers for Disease Control and Prevention (CDC) as uninfected operative wounds with no inflammation and no entry into sterile tracts (e.g., gastrointestinal or respiratory systems), are influenced by various perioperative factors. The Certification Board of Infection Control and Epidemiology (CBIC) emphasizes identifying and mitigating risk factors in the "Prevention and Control of Infectious Diseases" domain, aligning with CDC guidelines for surgical site infection (SSI) prevention. The question focuses on identifying a procedure not documented as a contributor to SSIs, requiring an evaluation of evidence-based risk factors.
Option C, "The use of iodophors for preoperative scrubs," has not been documented to contribute to the development of postoperative infections in clean surgical operations. Iodophors, such as povidone-iodine, are antiseptic agents used for preoperative skin preparation and surgical hand scrubs. The CDC's "Guideline for Prevention of Surgical Site Infections" (1999) and its 2017 update endorse iodophors as an effective method for reducing microbial load on the skin, with no evidence suggesting they increase SSI risk when used appropriately. Studies, including those cited by the CDC, show that iodophors are comparable to chlorhexidine in efficacy for preoperative antisepsis, and their use is a standard, safe practice rather than a risk factor.
Option A, "Prolonged preoperative hospital stay," is a well-documented risk factor. Extended hospital stays prior to surgery increase exposure to healthcare-associated pathogens, raising the likelihood of colonization and subsequent SSI, as noted in CDC and surgical literature (e.g., Mangram et al., 1999). Option B,
"Prolonged length of the operations," is also a recognized contributor. Longer surgical durations are associated with increased exposure time, potential breaches in sterile technique, and higher infection rates, supported by CDC data showing a correlation between operative time and SSI risk. Option D, "Shaving the site on the day prior to surgery," has been documented as a risk factor. Preoperative shaving, especially with razors, can cause microabrasions that serve as entry points for bacteria, increasing SSI rates. The CDC recommends avoiding shaving or using clippers immediately before surgery to minimize this risk, with evidence from studies like those in the 1999 guideline showing higher infection rates with preoperative shaving.
The CBIC Practice Analysis (2022) and CDC guidelines focus on evidence-based practices, and the lack of documentation linking iodophor use to increased SSIs-coupled with its role as a preventive measure-makes Option C the correct answer. The other options are supported by extensive research as contributors to SSI development in clean surgeries.
References:
* CBIC Practice Analysis, 2022.
* CDC Guideline for Prevention of Surgical Site Infections, 1999, updated 2017.
* Mangram, A. J., et al. (1999). Guideline for Prevention of Surgical Site Infection. Infection Control and Hospital Epidemiology.
NEW QUESTION # 159
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